Health Care And The Growing Ethic Of Entitlement

November 24, 1991|By Stephen Chapman.

When the Bush administration recently proposed a universal health card to provide patient information and simplify billing, Washington Post columnist Robert Kuttner waxed scornful. ``It is very much like cards carried by Canadians, the British, Germans, Swedes and inhabitants of other civilized nations, with the one key difference that you`re on your own when it comes to paying the bill,`` he wrote. ``It is a bit like a credit card with no line of credit.``

Imagine that. Americans who want health care will continue to be deprived of the option of consuming all they desire and sending the bill to someone else. They will actually be expected to pay (or arrange for an insurer to pay) for their treatment as if it were any other commodity. What could be more outrageous? Next thing you know we`ll be expected to pay for our own food, shelter and clothing.

Kuttner is wrong in his thinking about health care, but he has plenty of company. When Americans complain about their medical system, they aren`t unhappy with their doctors, the quality of treatment or the availability of services. More than 90 percent say they are personally satisfied with their care.

But thanks to Medicare, Medicaid, public hospitals, tax-subsidized employee health insurance and other government programs, Americans have gotten the idea that every person has a right to the best care at someone else`s expense. If medical care is a right, it`s deeply unjust to demand any financial sacrifice from its recipients. Here, the entitlement ethic has spread far and wide. Everyone wants to live at the expense of everyone else.

This desire is encouraged by the belief that people elsewhere have invented a way to do just that. Canada allows patients to choose their private doctors, but virtually all bills are paid, and all fees set, by the government. Its approach has reputedly given Canada both lower medical costs and better health than the United States. Canadians, unlike Americans, are also happy with their system.

But it`s easy to see why it enjoys such popularity: It`s practically free. The U.S. Postal Service may not work very well, but if you could send anything from a first-class letter to a truckload of furniture at no cost, you`d probably be content with it.

Neither mail nor medicine can really be delivered for free-citizens pay directly in fees or indirectly in taxes. But by separating the payment from the service, the government allows its constituents to think they`re getting something for nothing.

Getting health care ``free`` distracts Canadians from disagreeable facts, such as these: Their health care costs have grown faster than ours in the last 20 years, people needing surgery generally have to endure long waits, and many forms of technology that Americans take for granted are pathetically scarce. If Canadians enjoy better health than Americans, it`s largely due to causes unrelated to medicine, like lower rates of crime and poverty.

Letting Washington assume all responsibility for paying for every citizens` medical care is supposed to save us all huge sums in administrative costs by substituting a single payer for the hundreds that exist now. If you believe this, you`ll believe that cars would be cheaper if only one manufacturer were allowed to sell them.

That`s no stranger than thinking the demand for medical care won`t soar once patients are freed from the burden of payment. If the government assured every American a new car every five years at public expense, the nation would soon find itself spending a lot more on automobiles.

Prescribing more government involvement as a cure is like asking the doctor who botched your appendectomy to handle your heart bypass. Economist Milton Friedman notes that since Medicare and Medicaid began in 1965, the average cost of a day in the hospital has risen eightfold. Yet the number of beds has dropped, and improvements in health have slowed.

By spending more on medical care, the government has caused us all to get less medical care. It has also rapidly driven up the cost of treatment, making it harder for anyone but the government to afford.

If Washington were to find a way to spend less-say, by requiring every household to buy private health insurance to cover major expenses-the demand for health care would fall, doctors and hospitals would be forced to reduce their prices and total expenditures on health care would decline. The efficiencies generated by competition would provide the same benefits to health care recipients that Japanese automakers have provided to American consumers.

But that approach would also force Americans to recognize that they can`t have all the health care they want for nothing. Right now that delusion seems too inviting to resist.